<template>
  <div class="container-fluid">
    <div class="page-header">
      <h1 class="page-heading">编辑患者</h1>
    </div>
    <div class="card mb-4">
      <div class="card-body">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">住院号</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">手机号</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">姓名</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">性别</label>
              <div class="col-9 d-flex">
                <div class="form-check">
                  <input class="form-check-input" id="customRadioInline1" type="radio" name="customRadioInline1">
                  <label class="custom-control-label" for="customRadioInline1">男</label>
                </div>
                <div class="form-check mx-3">
                  <input class="form-check-input" id="customRadioInline2" type="radio" name="customRadioInline1">
                  <label class="custom-control-label" for="customRadioInline2">女</label>
                </div>
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">出生日期</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">科室</label>
              <div class="col-9 select">
                <select class="form-control" name="account">
                  <option>系统科室</option>
                </select>
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">状态</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">责任医生</label>
              <div class="col-9 select">
                <select class="form-control" name="account">
                  <option>张三</option>
                </select>
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">责任护士</label>
              <div class="col-9 select">
                <select class="form-control" name="account">
                  <option>李四</option>
                </select>
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">床号</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">入院时间</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">出院时间</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">糖尿病类型</label>
              <div class="col-9 select">
                <select class="form-control" name="account">
                  <option>系统科室</option>
                </select>
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">诊断时间</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">入院诊断</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">出院诊断</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">新生儿</label>
              <div class="col-9 d-flex">
                <div class="form-check">
                  <input class="form-check-input" id="a1" type="radio" name="a">
                  <label class="custom-control-label" for="a1">是</label>
                </div>
                <div class="form-check mx-3">
                  <input class="form-check-input" id="a2" type="radio" name="a">
                  <label class="custom-control-label" for="a2">否</label>
                </div>
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">婚姻状况</label>
              <div class="col-9 d-flex">
                <div class="form-check">
                  <input class="form-check-input" id="b1" type="radio" name="b">
                  <label class="custom-control-label" for="b1">已婚</label>
                </div>
                <div class="form-check mx-3">
                  <input class="form-check-input" id="b2" type="radio" name="b">
                  <label class="custom-control-label" for="b2">未婚</label>
                </div>
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">家族史</label>
              <div class="col-9 d-flex">
                <div class="form-check">
                  <input class="form-check-input" id="c1" type="radio" name="c">
                  <label class="custom-control-label" for="c1">有</label>
                </div>
                <div class="form-check mx-3">
                  <input class="form-check-input" id="c2" type="radio" name="c">
                  <label class="custom-control-label" for="c2">无</label>
                </div>
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">是否吸烟</label>
              <div class="col-9 d-flex">
                <div class="form-check">
                  <input class="form-check-input" id="d1" type="radio" name="d">
                  <label class="custom-control-label" for="d1">有</label>
                </div>
                <div class="form-check mx-3">
                  <input class="form-check-input" id="d2" type="radio" name="d">
                  <label class="custom-control-label" for="d2">无</label>
                </div>
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">是否饮酒</label>
              <div class="col-9 d-flex">
                <div class="form-check">
                  <input class="form-check-input" id="e1" type="radio" name="e">
                  <label class="custom-control-label" for="e1">有</label>
                </div>
                <div class="form-check mx-3">
                  <input class="form-check-input" id="e2" type="radio" name="e">
                  <label class="custom-control-label" for="e2">无</label>
                </div>
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">身份证类型 </label>
              <div class="col-9 select">
                <select class="form-control" name="account">
                  <option>居民身份证</option>
                  <option>居民户口本</option>
                  <option>护照</option>
                  <option>军官证</option>
                  <option>驾驶证</option>
                  <option>港澳居民来往内地通行证</option>
                  <option>台湾居民来往内地通行证</option>
                  <option>母亲身份证</option>
                  <option>其他法定有效证件</option>
                </select>
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">身份证号码</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">医保类型</label>
              <div class="col-9 d-flex">
                <div class="form-check">
                  <input class="form-check-input" id="f1" type="radio" name="f">
                  <label class="custom-control-label" for="f1">医保</label>
                </div>
                <div class="form-check mx-3">
                  <input class="form-check-input" id="f2" type="radio" name="f">
                  <label class="custom-control-label" for="f2">自费</label>
                </div>
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">医保卡</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">健康卡卡号</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">家属手机号</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">户籍地址</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">住址</label>
              <div class="col-9">
                <input class="form-control" type="text">
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-sm-12 col-md-6">
            <div class="row">
              <label class="text-center col-3 form-label">备注</label>
              <div class="col-9">
                <textarea class="form-control" type="text" placeholder="请填写备注内容"/>
              </div>
            </div>
          </div>
        </div>
        <hr class="bg-gray-400 my-4">
        <div class="row gy-4">
          <div class="col-9 mx-5">
            <button class="btn btn-secondary mx-2 px-4" type="submit" @click="$router.go(-1)">提交</button>
            <button class="btn btn-primary px-4" type="submit" @click="$router.go(-1)">取消</button>
          </div>
        </div>
      </div>
    </div>
  </div>
</template>

<script>
</script>

<style>
</style>
